Heart Attack Treatment (cont.)

Daniel Lee Kulick, MD, FACC, FSCAI

Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Angiotensin converting enzyme (ACE) inhibitors

Angiotensin
converting enzyme (ACE) inhibitors, another class of blood vessel dilators,
often are given orally after a large heart attack to improve the healing of
heart muscle. Examples of ACE inhibitors include captopril (Capoten), enalapril
(Vasotec), lisinopril (Zestril and Prinivil), and ramipril (Altace). These
medications lower the blood pressure and reduce the workload of the heart,
thereby helping the damaged heart muscle to recover. They are especially helpful
in patients who have recovered from heart attacks but have high blood pressure,
heart failure, major damage to the left ventricle, and diabetes mellitus.
For additional information, please see the ACE
Inhibitors article.

Beta blockers

Beta blockers such as propranolol (Inderal), metoprolol (Lopressor, Toprol
XL), and atenolol (Tenormin)
usually are given early during a heart attack and are continued
long-term. Beta blockers antagonize the action of adrenaline and relieve stress
on the muscles of the heart. Beta blockers decrease the workload of
the heart by slowing the heart rate and decreasing the force of contraction of
heart muscle. Decreasing the workload decreases the demand for oxygen by
the heart and limits the amount of damage to the heart muscle. Long-term administration of
beta blockers following a heart attack has been shown to improve
survival and reduce the risk of future heart attacks. Beta blockers also improve survival
among patients with heart attacks by decreasing the incidence of
life-threatening abnormal heart rhythms, for example, ventricular fibrillation.
Beta blockers can be given intravenously in the hospital and then can be taken
orally for long-term treatment.

The side effects of beta blockers are wheezing
(worsening of breathing in patients with
asthma), abnormally slow heart rate,
and exacerbation of heart failure (especially in patients with significant
damage to their heart muscle); however, in patients with chronic heart failure,
beta blockers have recently been demonstrated to be helpful in decreasing
symptoms and prolonging life. For more, please read the
Beta Blockers article.